Credentialing Specialist, Bureau of Revenue
Core
Verify clinical provider qualifications and manage insurance network enrollment to ensure regulatory compliance and revenue collection for patient care.
Role type
Healthcare credentialing and provider enrollment specialist
Builds
Compliant provider profiles and insurance network eligibility for reimbursement
Domain
Healthcare administration / Public health
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Healthcare credentialing verification, Insurance network enrollment (Medicare/Medicaid/commercial), Database management (CAQH Proview, PECOS, NPPES), Compliance monitoring, Medical billing data updates, Third-party billing support
Preferred skills
Article 28/31/36 clinic billing knowledge, Managed Care contracting experience, Third-party reimbursement adjudication, Medical billing and coding, Accounting computations
Technologies
CAQH Proview, PECOS, NPPES, Microsoft Office (Excel/Word)
Responsibilities
Review professional licenses, medical education, training, and certifications; Coordinate provider enrollment with insurance networks; Maintain provider profiles in databases; Track license and plan expiration dates; Conduct clinic visits for annual renewals and onboarding; Update billing systems with provider credentials; Assist with third-party billing and collection activities.
Seniority
Mid-level individual contributor